To be eligible for SilverScript sponsored by the GIC, you must meet all of the following criteria:
- Be eligible for Medicare Part A for free and enrolled in Medicare Part B
- Live in the SilverScript service area which is the United States and its territories
- Be a GIC retiree, survivor, or a covered spouse/dependent of a GIC retiree
- Be enrolled in any GIC Medicare products
- Continue to pay your Medicare Part B premium, and if required by Medicare because of your income, the Part D surcharge (called the D-IRMAA)
- Meet and maintain any of the GIC’s eligibility requirements for the plan
How to enroll in the SilverScript plan
You will automatically be enrolled in the SilverScript plan by the GIC when you enroll in a GIC Medicare plan.
What happens to your coverage if you are enrolled in another Part D plan
You can be enrolled in only one Medicare prescription drug plan at a time. If you are enrolled in another Medicare prescription drug plan or a Medicare Advantage plan, you will be disenrolled from that plan when you enroll in a GIC Medicare plan.
Likewise, if you enroll in another Medicare prescription drug plan or a Medicare Advantage plan, you will be disenrolled from the GIC-sponsored SilverScript plan. If you are disenrolled from SilverScript, you will lose your GIC medical, prescription drug and behavioral health coverage.
Late Enrollment Penalty for Medicare Part D
The Part D Late Enrollment Penalty (LEP) is the amount that Medicare requires a person to pay if he/she:
- Did not enroll in a Medicare prescription drug plan when first eligible for Medicare; or
- Did not have creditable prescription drug coverage – coverage at least as good as Medicare’s standard plan; or
- Had a break in coverage of more than 63 consecutive days.
The GIC’s retiree prescription drug coverage has always met or exceeded Medicare Part D coverage standard and has therefore been considered creditable coverage. See your health plan handbook for a Creditable Coverage notice.
If SilverScript contacts you, they may need information about your past prescription drug coverage to send to Medicare. Please make sure you provide the information requested in the notice. You may also ask that any decision about your late enrollment penalty be reconsidered.
If you decide to cancel your GIC coverage in the future and enroll in a non-GIC Medicare Part D plan, you will be responsible for the Medicare Part D late enrollment penalty.
What to do if your drug is not on the formulary you receive from SilverScript
For drugs not listed on the formulary, call SilverScript at 1.877.876.7214 to find out if it is covered. TTY users should call 711. Some drugs are covered through the GIC’s additional coverage.
What you need to do if your drug can be covered under Part B or Part D
Certain drugs may be covered under Part B for some medical conditions and under Part D for other medical conditions. If you take a drug that could be covered under Medicare Part B or Medicare Part D, you will have to get a Part B or Part D determination before the drug can be filled.
Contact SilverScript at 1.877.876.7214. TTY users should call 711.
Medicare Part D rates
If your modified adjusted gross income reported on your federal tax return is above a certain amount, Medicare requires that you pay an extra amount for your Medicare coverage. It is called an Income-Related Monthly Adjustment Amount or IRMAA. For Medicare Part D, it is referred to as “D-IRMAA.”
For more info, please visit social security.
Medicare Part D Extra Help
Extra Help is a Medicare program that helps individuals who have low income and resources to pay for prescription drug costs. For 2019, you may qualify if you have
- No more than $18,735 in income or $14,390 in resources for an individual
- No more than $25,365 in income or $28,720 in resources for a married couple
If Medicare identifies you as a person who qualifies for Extra Help to pay for your prescription drug costs, you will receive a letter from Medicare or the Social Security Administration.
Some people automatically qualify for Extra Help, for instance if they have full Medicaid coverage, get help from Medicaid to pay their Part B premiums or if they receive Supplemental Security Income (SSI) benefits.
To see if you qualify for Extra Help, you can:
- Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Available 24 hours a day, 7 days a week.
- Go online at Medicare’s Website.
- Call Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
- Go online at Social Security’s Website.
How Extra Help works with your GIC coverage
If you qualify for Extra Help, your prescription drug costs will be reduced. Extra Help copays range from $0 to 15% coinsurance. The Low Income Subsidy Rider, which will be included with your SilverScript ID card, will tell you the exact amount of your copay or coinsurance.
Medication Therapy Management
Medicare requires Medicare prescription drug plans to offer an optional, free service called Medication Therapy Management (MTM). If you take multiple medications, have a chronic condition or high drug costs, you may be invited to participate in a MTM program designed for your specific health issue. You may choose not to participate, but you should consider taking advantage of this free service. Contact SilverScript for additional details.
Preferred network pharmacies
SilverScript has preferred network retail pharmacies where you can get up to a 90-day supply of your maintenance medications for the same copay as mail-order. Current preferred network pharmacies include CVS Pharmacy®, Longs Drugs (operated by CVS Pharmacy) and Navarro.
Visit SilverScript’s website at SilverScript's website, or call SilverScript at 1.877.876.7214 to find the preferred network pharmacies near you. TTY users should call 711.
You may get your prescriptions filled at a pharmacy that is not part of SilverScript’s pharmacy network
Prescriptions filled at out-of-network pharmacies are only covered in an emergency. If you have any questions about whether or not your prescription will be covered at an out-of-network pharmacy, call SilverScript at 1.877.876.7214. TTY users should call 711.
If you use an out-of-network pharmacy, you will have to pay the full cost for your prescription and submit a paper claim available on SilverScript’s website and your itemized receipt to SilverScript for reimbursement.
You may continue to get your prescriptions filled at a Veterans Affairs (VA) pharmacy
VA pharmacies are not included in Medicare Part D plan networks including SilverScript. The federal government does not allow anyone to receive benefits from more than one government program at the same time. However, if you are eligible for VA benefits, you may still use VA pharmacies under your VA benefits. Contact the VA Administration to find out the copay for the drugs you get filled and also contact SilverScript for copay details so you can compare the two programs and determine the best option for you. If you go to a retail pharmacy, such as CVS, Walgreens, or any other retail pharmacy, the claim will first process under your SilverScript Medicare Part D benefit, then it will process through TRICARE, where applicable. Questions concerning coordination of benefits, should be directed to TRICARE.
If you travel abroad, you may need to prepare in advance of leaving the country
Medicare Part D does not offer drug coverage outside of the country. You can call SilverScript at 1.877.876.7214 and request a vacation override for up to a 90-day supply before leaving the country. TTY users should call 711.
What happens if you need to get a prescription filled while you are out of the country
You will need to pay for the medication and save the itemized receipt. Send the itemized receipt with the completed SilverScript claim form (available at SilverScript's website) to the GIC and we will arrange to have you reimbursed for the cost of the prescription minus your copay, as long as the prescription is a covered drug and within the requirements of the plan design.